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Clemens CR, Alten F, Eter N, Helbig H, Märker DA. [Lens injury as a complication of intravitreal medication injection]. DIE OPHTHALMOLOGIE 2024; 121:385-390. [PMID: 38363379 DOI: 10.1007/s00347-024-01997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 09/21/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Intravitreal medication injections are an efficient and low-risk delivery technique for treating various retinal diseases. Rare serious complications include increased intraocular pressure, vitreous hemorrhage, retinal tears and detachment, intraocular inflammation and endophthalmitis. In the case series presented here, we report iatrogenic lens injuries caused by inadequate performance of intravitreal injections. METHODS A multicenter data collection of patients treated with intravitreal injections with visible iatrogenic lens defects from 2016 to 2023 was retrospectively performed. RESULTS Lens trauma after intravitreal injections was identified in six cases (69.3±6.5 years). While five cases were observed after anti-VEGF therapy, we identified lens injury after dexamethasone implantation in one patient. CONCLUSION Iatrogenic lens injury during intravitreal injection is preventable with the correct injection technique. Knowledge of individual axis length and lens status also helps to avoid this complication.
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Affiliation(s)
- Christoph R Clemens
- Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland.
| | - Florian Alten
- Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Nicole Eter
- Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Horst Helbig
- Universitäts-Augenklinik Regensburg, Regensburg, Deutschland
| | - David A Märker
- Universitäts-Augenklinik Regensburg, Regensburg, Deutschland
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Altunel O, Irgat SG, Özcura F. Objective evaluation of changes in lens clarity after repeated injections of ranibizumab in patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2022; 260:2897-2904. [PMID: 35445877 DOI: 10.1007/s00417-022-05668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/30/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To objectively evaluate changes in lens densitometry in eyes with neovascular age-related macular degeneration (n-AMD) treated with repeated intravitreal ranibizumab injections during a 12-month period and to compare the results with those in untreated healthy fellow eyes and healthy control eyes. METHODS In this prospective study, the 36 treated eyes and the 37 untreated fellow eyes of 38 patients with n-AMD and the 32 control eyes of 32 healthy individuals were analyzed. Lens densitometry was evaluated using the Scheimpflug imaging. All data in both groups regarding lens densitometry were recorded at baseline and 12 months. RESULTS The mean densitometry of zone 1 in the treated eyes of patients had increased significantly at 12 months compared with the baseline (baseline: 9.3 ± 1.5, 12 months: 11.9 ± 1.7, p = .004) and was significantly greater than those measurements in the fellow eyes (9.8 ± 1.6 p = .02) and control eyes (9.6 ± 1.9, p = .01) at 12 months as well. There were no significant differences in terms of densitometry values between the fellow and control eyes at baseline and 12 months (for all, p > .05). CONCLUSIONS Our results objectively demonstrate early nuclear lens density changes using with Scheimpflug images in eyes with n-AMD that were treated with repeated ranibizumab injections for 12 months.
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Affiliation(s)
- Orhan Altunel
- Department of Ophthalmology, Kutahya Health Sciences University School of Medicine, Kütahya, Turkey.
| | - Saadet Gültekin Irgat
- Department of Ophthalmology, Kutahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Fatih Özcura
- Department of Ophthalmology, Kutahya Health Sciences University School of Medicine, Kütahya, Turkey
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Dawson VJ, Patnaik JL, Wildes M, Bonnell LN, Miller DC, Taravella MJ, Lynch AM, Christopher KL. Risk of posterior capsule rupture in patients with type 2 diabetes mellitus and diabetic retinopathy during phacoemulsification cataract surgery. Acta Ophthalmol 2022; 100:813-818. [PMID: 35253993 DOI: 10.1111/aos.15121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/19/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Valerie J. Dawson
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Michael Wildes
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Levi N. Bonnell
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - D. Claire Miller
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Michael J. Taravella
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Anne M. Lynch
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Karen L. Christopher
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
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Bjerager J, Dijk EHC, Holm LM, Singh A, Subhi Y. Previous intravitreal injection as a risk factor of posterior capsule rupture in cataract surgery: a systematic review and meta-analysis. Acta Ophthalmol 2022; 100:614-623. [PMID: 35060678 DOI: 10.1111/aos.15089] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/25/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Intravitreal injections and cataract surgery are two common procedures in the elderly. Posterior capsular rupture (PCR) is a rare but important complication of cataract surgery. We systematically reviewed the literature on previous intravitreal injections as a risk factor of PCR and performed meta-analyses to provide pooled summary risk estimates. METHODS We searched 13 literature databases on 1 June 2021 for studies evaluating the risk of PCR in eyes undergoing cataract surgery with data on previous intravitreal injections. Data extraction was made independently by two authors and discussed afterwards until reaching consensus. Random effects meta-analyses on the pooled odds ratio (OR) of PCR in eyes with previous intravitreal injections were made using MetaXL 5.3. RESULTS Six studies on 1 051 097 eyes undergoing cataract surgery were eligible for the qualitative and quantitative review. Previous history of intravitreal injections was present in 7034 eyes (majority was anti-VEGF). Our meta-analyses revealed that any previous intravitreal injection was a risk factor for PCR with an OR of 2.30 (95% CI 1.39-3.81). For each previous intravitreal injection, the risk of PCR was OR 1.04 (95% CI 1.01-1.08) (equivalent of relative risk ~1.04). In other words, risk of PCR increases by 4% for each previous intravitreal injection. CONCLUSIONS Previous intravitreal injection is a risk factor for PCR and should be taken into account when planning cataract surgery. However, to be regarded as a clinically significant risk of PCR, a substantial number of previous intravitreal injection (e.g. ≥10) should have been administered, considering that the a priori risk of PCR is very low (~1%).
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Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
| | - Elon H. C. Dijk
- Department of Ophthalmology Leiden University Medical Center Leiden The Netherlands
| | - Lars Morten Holm
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Amardeep Singh
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
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Zhong Z, He Z, Yu X, Zhang Y. Intravitreal injection is associated with increased posterior capsule rupture risk during cataract surgery: A meta-analysis. Ophthalmic Res 2021; 65:152-161. [PMID: 34942626 DOI: 10.1159/000521576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although observational studies have suggested that prior intravitreal therapy may predict posterior capsule rupture (PCR) during cataract surgery, this finding is still controversial. OBJECTIVE To summarize current evidence on the association between prior intravitreal injection (IVI) and PCR during cataract surgery. METHODS A systematic literature search was performed up to October 27th, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. The potential association between IVI and PCR in future cataract surgeries was assessed using the following two models: "pooling the odds ratios of PCR in eyes with and without previous IVI(s)" and "pooling the odds ratios for PCR relative to each increase in the number of prior injections." The quality of included studies was appraised using the Newcastle-Ottawa Scale. RESULTS 6 cohort studies were included in this meta-analysis, with a total of 1,051,097 eyes that underwent cataract surgery. Of these, 7,034 eyes were associated with previous IVI. The pooled odds of PCR in eyes with prior IVI was 2.01 (95% CI: 1.35-3.00) times higher than that of eyes without an IVI history. An increase in the number of previous IVI conferred increased odds of PCR of 1.03 (95% CI: 1.01-1.06). After excluding studies that failed to account for confounders, the significantly increased risk was not altered, and the significant heterogeneity was minimized in both models. CONCLUSION This meta-analysis provides evidence that previous IVI significantly increases the risk of PCR during future cataract surgery. The risk of PCR should be discussed preoperatively with patients. Further studies are required to validate our findings and explore the underlying mechanisms.
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Affiliation(s)
- Zhe Zhong
- Department of Ophthalmology, The Third Affiliated Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District), Foshan, China
| | - Zhenghua He
- Department of Otolaryngology, The Third Affiliated Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District), Foshan, China
| | - Xi Yu
- Cataract Special Department, Aier Eye Hospital of Yichun, Yichun, China
| | - Ying Zhang
- Department of Ophthalmology, The Third Affiliated Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District), Foshan, China
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Alishahedani ME, Yadav M, McCann KJ, Gough P, Castillo CR, Matriz J, Myles IA. Therapeutic candidates for keloid scars identified by qualitative review of scratch assay research for wound healing. PLoS One 2021; 16:e0253669. [PMID: 34143844 PMCID: PMC8213172 DOI: 10.1371/journal.pone.0253669] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
The scratch assay is an in vitro technique used to analyze cell migration, proliferation, and cell-to-cell interaction. In the assay, cells are grown to confluence and then ‘scratched’ with a sterile instrument. For the cells in the leading edge, the resulting polarity induces migration and proliferation in attempt to ‘heal’ the modeled wound. Keloid scars are known to have an accelerated wound closure phenotype in the scratch assay, representing an overactivation of wound healing. We performed a qualitative review of the recent literature searching for inhibitors of scratch assay activity that were already available in topical formulations under the hypothesis that such compounds may offer therapeutic potential in keloid treatment. Although several shortcomings in the scratch assay literature were identified, caffeine and allicin successfully inhibited the scratch assay closure and inflammatory abnormalities in the commercially available keloid fibroblast cell line. Caffeine and allicin also impacted ATP production in keloid cells, most notably with inhibition of non-mitochondrial oxygen consumption. The traditional Chinese medicine, shikonin, was also successful in inhibiting scratch closure but displayed less dramatic impacts on metabolism. Together, our results partially summarize the strengths and limitations of current scratch assay literature and suggest clinical assessment of the therapeutic potential for these identified compounds against keloid scars may be warranted.
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Affiliation(s)
- Mohammadali E. Alishahedani
- Epithelial Therapeutics Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, North Bethesda, Maryland, United States of America
| | - Manoj Yadav
- Epithelial Therapeutics Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, North Bethesda, Maryland, United States of America
| | - Katelyn J. McCann
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, United States of America
| | - Portia Gough
- Epithelial Therapeutics Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, North Bethesda, Maryland, United States of America
| | - Carlos R. Castillo
- Epithelial Therapeutics Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, North Bethesda, Maryland, United States of America
| | - Jobel Matriz
- Epithelial Therapeutics Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, North Bethesda, Maryland, United States of America
| | - Ian A. Myles
- Epithelial Therapeutics Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, North Bethesda, Maryland, United States of America
- * E-mail:
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Miller DC, Christopher KL, Patnaik JL, Lynch AM, Seibold LK, Mandava N, Taravella MJ. Posterior Capsule Rupture during Cataract Surgery in Eyes Receiving Intravitreal anti-VEGF Injections. Curr Eye Res 2020; 46:179-184. [PMID: 32657614 DOI: 10.1080/02713683.2020.1795884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the risk of posterior capsule rupture (PCR) during phacoemulsification cataract surgery in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections prior to surgery. METHODS A retrospective study was conducted of cataract surgeries at the Sue Anschutz-Rodgers UCHealth Eye Center from January 1, 2014, through December 31, 2018. The primary outcome was the occurrence of PCR during surgery. Other variables of interest included age, race, sex, ocular comorbidities, diabetes, mature cataract, primary surgeon, injection frequency and type, and date of most recent injection. Predictors of PCR were assessed using logistic regression with generalized estimating equations to account for correlation between patient eyes. Additional sub-analysis was performed on eyes with PCR with and without anti-VEGF injection history to compare intraoperative characteristics, post-operative complications, and visual outcomes. RESULTS In total 10,327 cataract surgeries were included in the analysis, and 308 of these eyes received anti-VEGF injections prior to surgery. Of the 308 eyes that received anti-VEGF injections, eight (2.6%) had a PCR during surgery compared to 45 of 10,019 eyes (0.5%) that did not receive injections (unadjusted OR = 5.9, 95% CI: 2.8-12.7, p < .0001). Males and diabetics were more likely to have received injections and had higher rates of PCR, so these variables were adjusted for in the multivariate analysis of the association between injections and PCR (adjusted OR = 4.7, 95% CI: 2.1-10.4, p-value = 0.0001). Eyes with mature cataracts and those that underwent surgery with a resident as the primary surgeon were also at higher risk of PCR, but these variables were not associated with the anti-VEGF injection. Injection frequency, time between most recent injection and surgery, and type of anti-VEGF agent were not significantly associated with PCR. CONCLUSIONS History of intravitreal anti-VEGF injections was associated with higher odds of PCR during cataract surgery.
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Affiliation(s)
- D Claire Miller
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Karen L Christopher
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Leonard K Seibold
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
| | - Michael J Taravella
- Department of Ophthalmology, University of Colorado School of Medicine , Aurora, CO, USA
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Hwang JH, Jeong KD, Chung KH, Park JH, Choi J, Oh WH, Kim JS. Intravitreal Bevacizumab for Inflammatory Neovascularization of the Lens after Traumatic Open Globe Injury. Ocul Immunol Inflamm 2020; 28:699-702. [PMID: 31268802 DOI: 10.1080/09273948.2019.1609048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To describe a case of inflammatory neovascularization of the lens after open globe injury. Case report. A 57-year-old man presented with severe inflammation, posterior synechiae with traumatic cataract, and thick neovascularization of the intralenticular and anterior lens capsule after open globe injury in the left eye. We administered an intravitreal bevacizumab injection and performed cataract surgery with synechiolysis 1 month later. Inflammation after open globe injury may present as intralenticular neovascularization. Before cataract surgery for traumatic cataract with intralenticular neovascularization, the use of intravitreal bevacizumab injection was ineffective.
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Affiliation(s)
- Je Hyung Hwang
- Department of Ophthalmology Sanggye Paik Hospital, Inje University of Korea, College of Medicine , Seoul, Republic of Korea
| | - Kyeong Do Jeong
- Asan-si Healthcare Center , Chungcheongnam-do, Republic of Korea
| | - Kyu Ho Chung
- Department of Ophthalmology Sanggye Paik Hospital, Inje University of Korea, College of Medicine , Seoul, Republic of Korea
| | - Jung Hyun Park
- Department of Ophthalmology Seoul Paik Hospital, Inje University of Korea, College of Medicine , Seoul, Republic of Korea
| | - Jin Choi
- Department of Ophthalmology Sanggye Paik Hospital, Inje University of Korea, College of Medicine , Seoul, Republic of Korea
| | - Won Hyuk Oh
- Department of Ophthalmology Sanggye Paik Hospital, Inje University of Korea, College of Medicine , Seoul, Republic of Korea
| | - Jae Suk Kim
- Department of Ophthalmology Sanggye Paik Hospital, Inje University of Korea, College of Medicine , Seoul, Republic of Korea
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An SY, Lee YJ, Neupane S, Jun JH, Kim JY, Lee Y, Choi KS, An CH, Suh JY, Shin HI, Sohn WJ, Kim JY. Effects of vascular formation during alveolar bone process morphogenesis in mice. Histochem Cell Biol 2017; 148:435-443. [DOI: 10.1007/s00418-017-1584-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 01/02/2023]
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